Should teardrop breast implant be placed by armpit incision or infra-mammary incision?

Dear LauraAnnie,I tend to prefer the periareolar incision because its the most well hidden. There is a natural border between the areola and the rest of the breast skin the hides the incision extremely well. You have to be completely naked to see it vs other incisions like transaxillary and inframammary are visible in clothing such as sleeveless shirts and bikini tops when extending your arms up. I've also noticed increased rates of bottoming out with inframmary incisions that is not reported. Transaxillary implants are always wide in appearance because the surgeon is not able to dissect medially enough to provide better cleavage. Ultimately, I can perform any of the incisions but I recommend the periareolar. There is no difference in sensation because the nerves that control nipple sensation come in laterally from the back and injury to them occurs when surgeons dissect to far laterally which is why transaxillary incisions have the highest nipple sensation disruption. There is no difference in breast feeding ability. One study did show a slight increase in capsular contracture with use of periareolar but that study was small and did not incorporate modern techniques such as below muscle placement, keller funnel usage and triple antibiotic irrigation. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

The choice of incision in the setting of breast augmentation is one which is made jointly by both the patient and the surgeon. Surgeons typically have their preference as do patients. 
Your options include-
The DIRECT approaches:
-IMF (fold)- (+) popular, direct access with good visualization, if placed appropriately it is well tolerated and well camouflaged; (-) the scar can migrate as the fold descends with augmentation, the incision can be misplaced
-Infrareolar- (+) commonly used alternative to the IMF incision, the location is more consistent and predictable than the IMF, especially useful in those patients with a poorly defined fold; (-) there is a limitation based on the size of the areola (smaller areolas will limit incision size and thus impact visualization), this technique is also associated with slightly higher rates of contracture (due to the contention that there is low grade contamination associated with passage through breast tissue).
The INDIRECT approaches:
-Transaxillary (armpit)- (+) avoids a scar on the breast mound but must be performed endoscopically as there is no direct visualization of the pocket during dissection otherwise; (-) can be limiting with regards to implant size and type (although the Keller funnel has helped); saline is preferred, however, smaller silicone devices with a funnel are possible; form stable implants cannot be placed via this indirect route.
-Transumbilical (belly button)- (+) avoids a scar on the breast mound; (-) no direct visulization of the pocket, saline implants only.
The direct approaches remain the most popular with the IMF approach most commonly used. With regards to tear drop shaped devices orientation is paramount. Thus the direct IMF approach is preferred for orienting a shaped device.
Ultimately, no approach is perfect. They are different as is each surgeon. The incision decision is best made in concert with your board certified plastic surgeon (ABPS).

Hello,The IM incision is the right incision for all implants, not just shaped. Bacterial contamination of breast implants is the cause of the most common complication of breast augmentation, capsular contracture, and is probably the cause of the least common complication, BIA-ALCL. IM incisions help to reduce the risk of implant contamination, and is necessary for shaped implant placement. Best of luck!